Contact Information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

How did you hear about us?

TV         Billboard  Radio    
Referral   Newspaper  Web site    

Home Information: Which manufacturer are you interested in?

Fairmont
Stratford Modular
Wick Rollohomes
Friendship IN
All

Do you own land for your new home?

Yes No

Do you want your home placement in a park or on a private property?

Park Private Property

What size home are you planning to purchase?

Square Feet:

# of bedrooms:

# of baths:

Are you currently in a manufactured home?

Yes No

Do you own your own home or are you renting?

Own Renting

What is your price range?

What is your desired monthly payment?

Will you need financing?

Yes No

What is the size of your down payment?

When are you planning to purchase your home?

-- mm/dd/yy

Additional Information: